Download FETAL CIRCULATION

FETAL CIRCULATION
I.
FETAL CIRCULATORY ANATOMY AND REMNANTS AFTER BIRTH (Fig.
29.20a, b [29.21a,b) These can be seen on the fetal pig and on the illustrations.
The foramen ovale is seen on the illustration only (*). Observe the boldfaced
remnant structures on the heart models and torso liver model also.
FETAL STRUCTURE
II.
REMNANT AFTER BIRTH
Umbilical vessels
Umbilical arteries (2)
Umbilical vein (1)
Lateral umbilical ligaments
Round ligament of the liver
Umbilical cord
Umbilicus
Bypasses of the lungs
Ductus arteriosus
Foramen ovale*
Ligamentum arteriosus
Fossa ovalis
Bypass of the liver
Ductus venosus
Ligamentum venosum
THE FETAL CIRCULATION
A.
Placenta (Fig. 29.4 [29.5]) Observe the illustrations.
The placenta is a vascular organ, genetically part maternal and part fetal.
It enables maternal and fetal blood to flow close by one another,
separated only by permeable membranes. Maternal and fetal blood do
not mix, but the placenta allows for exchange of oxygen and carbon
dioxide; the fetal lungs are of course nonfunctional. It is a source of
nutrients to the fetus, and it removes wastes. It provides maternal
antibodies to the fetus. In effect, the placenta serves as the lungs,
digestive system, kidneys, and immune system of the fetus. It is also a
major source of reproductive and other hormones during the pregnancy.
Fetal arteriole*
Fetal venule*
Umbilical veins*
Umbilical arteries*
*Note that the color of fetal
blood is reversed in the fetal
vessels.
74
75
B.
Fetal blood flow (Fig.29.20a [29.21a]) Trace these pathways on the
illustration.
1.
Oxygenated (red) blood flows from the placenta via the umbilical
vein in the umbilical cord.
2.
Red blood from the umbilical vein continues as the ductus
venosus within the liver, and joins the inferior vena cava. It mixes
with “blue” blood within the vena cava. From this point the blood
that oxygenates the fetal tissues is mixed blood. However, the fetal
hemoglobin is able to pick up oxygen at a lower PO2.
3.
The lungs are collapsed and nonfunctional; they receive only
enough blood for their own growth. Most of the blood bypasses the
lungs in one of two ways:
a.
The ductus arteriosus is a short, wide artery that connects
the pulmonary trunk artery with the aorta. This allows most
blood to bypass the lungs, although some blood still enters
the right and left pulmonary arteries. There is considerable
resistance to blood flow into the lungs because they are
collapsed.
b.
Before birth, the pressure in the right heart is higher than the
pressure in the left heart. Because of this, the one-way
valve, the foramen ovale, lets blood bypass the lungs by
going from the right atrium to the left atrium.
4.
Mixed arterial blood flows through the same arteries as in the adult
to oxygenate the tissues. Used, “blue” blood leaves via the same
veins as in the adult and enters the superior or inferior vena cava.
5.
Mixed blood in the internal iliac arteries is sent out the two
umbilical arteries through the umbilical cord to the placenta,
where it becomes red, oxygenated blood. It also picks up nutrients
and releases wastes.
6.
The umbilical vein carries red blood from the placenta back to the
fetus.
76
C.
D.
Birth and the stimuli for the first breath:
1.
The sudden cooling as the child is born triggers the "gasp" reflex.
2.
Hypoxia and hypercapnia may occur during the birth.
3.
The breathing rhythm is immediate or begins after brief delay due
to increased hypoxia. Delays of 8 minutes are maximum tolerable.
The first breaths
Much extra effort is needed for the first breath. The child can
produce more than twice the effort needed. Normal compliance
(ease of inflation) is established about 40 minutes after birth.
III.
CIRCULATORY READJUSTMENTS AFTER BIRTH (Fig. 29.20b [29.21b)
A.
Since blood no longer circulates in the placenta, blood volume in the child
increases, causing increased pressure in the left ventricle, left atrium, and
aorta.
B.
Pulmonary resistance decreases five times as the lungs expand with air,
because the blood vessels are less compressed. Also the extra O2
causes vasodilation within the lungs. This decreases the pulmonary blood
pressure, right atrial and right ventricular pressures.
C.
Foramen ovale closure: This one-way valve between left and right atria
closes because due to the increase in left heart pressure and the
decrease in right heart pressure as outlined above. (It only allowed right to
left blood flow before birth.) This occurs immediately, but it grows closed
and becomes the fossa ovalis within months or years (or occasionally not
at all; if this is the case, the higher pressure in the left atrium after birth
keeps it closed).
D.
Closure of the ductus arteriosus: The smooth muscle wall of the ductus
arteriosus constricts due to the higher O2 availability, and closes fully
within one to eight days. Within one to four months, it is replaced with
fibrous tissue. It persists for life as the ligamentum arteriosus.
E.
Closure of the ductus venosus: This liver bypass conducts blood from
umbilical vein to the inferior vena cava. When umbilical blood flow ceases
immediately after birth, portal blood still bypasses the liver via the ductus
venosus, until the ductus venosus contracts one to three hours after birth.
This forces portal blood through the liver. The cause is unknown. The
ductus venosus becomes the ligamentum venosum.
77
IV.
F.
If it is not immediately cut, the umbilical cord may pulse for a few
minutes after the birth but before the placenta detaches from the uterine
wall. Even if the cord is not clamped, blood leakage from the cord will
stop due to a gel within it that swells upon exposure to air.
G.
The lack of blood flow to the wall of the umbilical arteries and vein
causes fibrosis of them. The arteries become the lateral umbilical
ligaments and the vein persists as the round ligament of the liver.
REVIEW QUESTIONS
A.
The fetal circulation
1.
Which organ systems in the fetus are nonfunctional?
_____________ _____________ ____________ ____________
2.
What organ provides for their functions before birth? ___________
3.
Which blood vessel takes red blood from the umbilical vein to the
inferior vena cava? __________________ __________________
4.
Name the two bypasses of the lungs._____________ _________
__________________ _____________________
5.
How many umbilical arteries are there? _______
6.
They branch off from what other arteries? ___________________
7.
Do the umbilical arteries carry red, mixed, or “blue” blood? _______
8.
Where do the umbilical arteries take the blood? _______________
9.
How many vessels are in the umbilical cord? _____________
10.
Is lung compliance high or low during the first breath? __________
78
B.
Circulatory adjustments after birth
1.
Before birth, the pressure in the right atrium is higher than in the
left atrium. After birth, which side has higher pressure? _________
2.
What happens at birth because of this pressure?
_____________________________________________________.
3.
What causes the ductus arteriosus to close? _________________
_____________________________________________________
4.
What does it become after birth? ________________________
______________________________
5.
What does the umbilical vein become? ______________
_______________________ ____ _____ _____________
Optional notes on the fetal circulation
1.
Do you wonder why the fetus’ tissues are nourished with mixed rather than fully
oxygenated blood? Here’s why: Only arterial blood is under enough pressure to
leave the fetus and return to the placenta to pick up oxygen. If the arterial blood
were already fully oxygenated, it could not load any more oxygen. But--only
arterial blood nourishes the tissues, as is true after birth; therefore, the fetus gets
mixed blood. The fetal hemoglobin compensates for this situation.
2.
Patent ductus arteriosus occurs when the ductus arteriosus fails to close after
birth. The blood recirculates from the aorta to the pulmonary trunk (higher
pressure to lower), and causes more work for both sides of the heart. It may be
corrected with medications, or may be surgically corrected.
3.
A septal defect (a “hole in the heart”) occurs when either the interatrial or
interventricular septum has a congenital perforation. Interatrial septal defects
are usually from a failure of the foramen ovale. to close. An interventricular
septal defect occurs early in development; there is no normal opening in the
interventricular septum before birth. Because the pressure in the left heart is
higher than in the right heart after birth, blood flows from the left side to the right
side, increasing the work load on both sides of the heart.